Chasing “Shadows”: Discovering the Subtleties of Sestamibi Scans to Facilitate Minimally Invasive Parathyroidectomy

Neychev, Vladimir; Kouniavsky, Guennadi; Shiue, Zita; Udall, Don; Somervell, Helina; Umbricht, Christopher B.; Zeiger, Martha A.

doi:10.1007/s00268-010-0800-1

Cited by 15 publications

(16 citation statements)

References 33 publications

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“…These studies reported that surgeon interpretation and radiology experience increased the likelihood of localization [44,[45][46][47]. The authors recommend that sestamibi scans be reviewed by experienced parathyroid surgeons, rather than relying on radiological interpretation alone [45][46][47].…”

Section: Localization Techniquesmentioning

confidence: 99%

“…Elevated levels of serum calcium and PTH are associated with a 95% risk of a diagnosis for classic PHPT; however, patients may have normal levels of phosphate, calcium or PTH. Serum calcium levels et al reported a sensitivity of 58.6% for nuclear medicine physicians, compared with 81.9% for both a surgeon and a nuclear medicine physician [47].…”

Section: Differential Diagnosis and Work-upmentioning

confidence: 99%

“…MIP allows patients to undergo focused parathyroidectomy and has the benefits of a smaller incision, a shorter operation duration, a shorter length of hospital stay, and fewer complications; it is also more cost-effective than the standard four-gland exploration [40,43,47]. A small incision is usually made ipsilateral to the preoperative localized adenoma.…”

Section: Surgical Optionsmentioning

confidence: 99%

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Current Concepts in the Presentation, Diagnosis and Management of Primary Hyperparathyroidism

Alhefdhi¹

2015

Surgery

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Review ArticleOpen Access IntroductionPrimary hyperparathyroidism (PHPT) is defined by an abnormal increase in the intrinsic activity of the parathyroid gland(s) that result in elevated parathyroid hormone (PTH) levels [1,2]. It is one of the most common endocrine disorders and is the most common cause of hypercalcemia. PHPT is one of the most common endocrine disorders and is the most common cause of hypercalcemia, which increases morbidity and mortality that result from cardiovascular, renal, and musculoskeletal pathologies. PHPT affects 1 in 500 females and 1 in 2,000 males aged >40 years, with a peak incidence in post-menopausal women. In the US, Europe, and Australia, the reported estimated incidence rates range from 25 to 30 per 100,000 person years, and the prevalence range from 1 to 21 per 1,000 individuals [1][2][3][4].PHPT has been a recognizable disease since the 1920s in both Europe and the US [5]. The first parathyroidectomy was performed in 1925 by Felix Mandl in Vienna, Austria; since then, the diagnosis and management of PHPT have progressed [5]. The purpose of this article is to review the current trends of PPT presentation, work-up, and management. Anatomy and PhysiologyHumans typically have four parathyroid glands located at the posterior capsule of the thyroid gland; in up to 15% of individuals have more than four and up to 3% have three identifiable glands [6]. The superior parathyroid glands arise from the IV pharyngeal pouch and migrate to the cephalad thyroid gland; they are usually located at the cricothyroid junction, 1 cm from the recurrent laryngeal nerve and the inferior thyroid artery. Inferior parathyroid glands arise from the III pharyngeal pouch and migrate caudally with the thymus; they are usually located on the posterolateral aspect of the inferior pole of the thyroid gland. Normal parathyroid glands are yellow or brown in color, oval in shape, 3-7 mm in length, and 30-40 mg in weight [7,8].A parathyroid gland consists of chief cells, oxyphilic cells, a thin fibrous capsule, and a network of adipose tissue, blood vessels, and glandular parenchyma [8]. Chief cells secrete PTH, which consists of 84 amino acid polypeptides. The normal serum PTH level range is 15-72 pg/mL, with a half-life of 2-4 min. Seventy percent of PTH metabolism occurs in the liver and 30% in the kidneys [9][10][11]. PTH is regulated by serum calcium, phosphorus, and vitamin D metabolites. The total normal calcium level should be 8.8-10.2 mg/dL (ionized calcium 2.2-2.6 mmol/L) to ensure optimum physiological functions [9][10][11]. PTH levels are inversely proportional to serum calcium levels, as high serum calcium levels decrease PTH release [5][6][7] and low serum calcium levels increase PTH secretion. This relationship enhances renal tubular calcium reabsorption, urinary phosphate excretion, osteoclastmediated bone resorption, and the conversion of 25-hydroxyvitamin D3 into 1,25-hydroxyvitamin D3, which increases calcium absorption from the bowel [9-11]. EtiologyNinety-five percent of PHPT cases are spora...

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Section: Localization Techniquesmentioning

confidence: 99%

Section: Differential Diagnosis and Work-upmentioning

confidence: 99%

Section: Surgical Optionsmentioning

confidence: 99%

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Current Concepts in the Presentation, Diagnosis and Management of Primary Hyperparathyroidism

Alhefdhi¹

2015

Surgery

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“…While we do not routinely use SUS, we do routinely analyze and interpret preoperative imaging with the radiology and nuclear medicine physicians. We have previously shown that when the surgeon and radiologist together carefully re-review preoperative sestamibi scans (initially called by the radiologists as being "negative" or "indeterminate"), subtleties can often be discovered that may change operative strategy from bilateral neck exploration to minimally invasive parathyroidectomy (MIP) in a substantial proportion of cases (63%) [7]. It worth noting that in such cases, MIP can be performed successfully 91% of the time with a cure rate of 98% [7].…”

mentioning

confidence: 99%

Reply to: Letter to the Editor on the article “Parathyroid surgery can be safely performed in a community hospital by experienced parathyroid surgeons: A retrospective cohort study”

Neychev

Ghanem

Blackwood

et al. 2016

International Journal of Surgery

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“…The two radio-pharmaceuticals used are 99m Tc-Sestamibi and 99m TcTetrofosmin. Despite its limitations and variable accuracy TS along with pre-operative ultrasound has an established role in centers which perform large volume parathyroid surgery (1,2). However there are technical and biological factors that affect the uptake of the 99m Tc in the parathyroid adenoma and potentially affect the sensitivity and specificity of scan.…”

Section: Introductionmentioning

confidence: 99%

Parathyroid nuclear scan. A focused review on the technical and biological factors affecting its outcome

Kannan

Milas

Neumann

et al. 2014

ccmbm

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Chasing “Shadows”: Discovering the Subtleties of Sestamibi Scans to Facilitate Minimally Invasive Parathyroidectomy

Abstract: With careful preoperative re-review of a negative or indeterminate sestamibi scan and the identification of subtleties in patients with a negative preoperative US scan, a successful MIP can be performed 91% of the time with a 98% cure rate.

Cited by 15 publications

References 33 publications

Current Concepts in the Presentation, Diagnosis and Management of Primary Hyperparathyroidism

Current Concepts in the Presentation, Diagnosis and Management of Primary Hyperparathyroidism

Reply to: Letter to the Editor on the article “Parathyroid surgery can be safely performed in a community hospital by experienced parathyroid surgeons: A retrospective cohort study”

Parathyroid nuclear scan. A focused review on the technical and biological factors affecting its outcome

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